Q: Always Have to Take Some Type of AD? Having Kidney Issues &
Lamictal, Trileptal

Dr. Phelps:
Hello! i just came across this sight whilst 'googling' lamictal, trileptal and
kidney/cholesterol issues. I was diagnosed just last year with BP II, and
apparently, according to my doctor, had been erroneously treated for plan old
depression most of my adult life. That being said, she started me on a course
of moodstabilizers--lamictal, Tripleptal and seroquel tossed in there for sleep
and anxiety. I recently started having extreme bilateral peripheral edema, and
am now going to start undergoing kidney analysis as apparently i have been
leaking protein from my urine for over a month. In addition, in this past year
my cholesterol has gone from 200 to 400. While there is some high cholesterol
in my family--all are mystified. I am 42, lean, pretty much vegetarian (fish)
exercise, no smoke,no drink. But i am told, like many BP's do tend to overdo
coffee :-). (better than the stuff i used to do in the 80's)
So i guess i am just sending this 'message' in a bottle for any feedback. My
new psychiatrist had concerns about all of this and lamictal (i had gotten up
to 400 mg) so i am now 2 days 'clean' from that. Seroquel had gotten up to 200
mg due to lots of personal anxieties (alleviated by getting OUT of a
relationship with a nice Borderline) so now i am off of that. Trileptal is at
1800 mg/day. I will probably have to have a kidney biopsy. My fear is that i
will get taken off all meds and have to wing it but i also want to heal my
kidneys. My doc just put me in 5mg of lexapro to keep some depression at bay.
And while i am here, i was curious, the psychiatrist who originally diagnosed
my BP (which is no shock, as my father was Bipolar I with three to four Major
manic episodes) said that due to my misdiagnosis, i will always have to take
some type of antidepressent as that is what my brain is now 'used' to--any
feedback on that? Thanks to anyone who might have some information or perhaps
direct me to another resource! I am quite distressed!
Thanks,

Sincerely,

Dear Ms. R --

You raise several important questions here. First of all, you may find it useful
to note that Trileptal it is quite commonly associated with peripheral edema,
and there should have been a clue about this in your bloodstream sodium levels,
which this medication causes to decrease, very commonly. If you had normal
sodium levels, it is much less likely that the edema would have been coming from
Trileptal, and that perhaps is the reason why your doctor was looking at
Lamictal. However, if you're levels were not normal, this could be quite a
simple matter and not a kidney problem. I presume your doctors know all about
this, and that therefore the answer is not so simple, but you would want to make
sure before worrying about your kidneys.

Secondly, as regards going on Lexapro, and this idea that you will always have
to take some type of antidepressant. Your doctor may know something that I do
not, as I have only your history here on which to proceed. However, his
interpretation I think it may reflect his experience rather than evidence we
could turn to in the psychiatric literature. It could be that he is concerned
that your depression will remain a significant target, just as it was before all
this.

In any case, it is useful to remember that there are at least nine
antidepressants which are not "antidepressants" as such. Among them are Lamictal
and Seroquel, but that still leaves seven others you could consider for
long-term management when the edema is better understood. Here is a list of
those nine
"antidepressants" that are not antidepressants.